Abstract

Background

In the Netherlands, prenatal screening follows an opting in system and comprises two
non-invasive tests: the combined test to screen for trisomy 21 at 12 weeks of gestation
and the fetal anomaly scan to detect structural anomalies at 20 weeks. Midwives counsel
about prenatal screening tests for congenital anomalies and they are increasingly
having to counsel women from religious backgrounds beyond their experience. This study
assessed midwives’ perceptions and practices regarding taking client’s religious backgrounds
into account during counseling. As Islam is the commonest non-western religion, we
were particularly interested in midwives’ knowledge of whether pregnancy termination
is allowed in Islam.

Methods

This exploratory study is part of the DELIVER study, which evaluated primary care
midwifery in the Netherlands between September 2009 and January 2011. A questionnaire
was sent to all 108 midwives of the twenty practices participating in the study.

Results

Of 98 respondents (response rate 92%), 68 (69%) said they took account of the client’s
religion. The two main reasons for not doing so were that religion was considered
irrelevant in the decision-making process and that it should be up to clients to initiate
such discussions. Midwives’ own religious backgrounds were independent of whether
they paid attention to the clients’ religious backgrounds. Eighty midwives (82%) said
they did not counsel Muslim women differently from other women. Although midwives
with relatively many Muslim clients had more knowledge of Islamic attitudes to terminating
pregnancy in general than midwives with relatively fewer Muslim clients, the specific
knowledge of termination regarding trisomy 21 and other congenital anomalies was limited
in both groups.

Conclusion

While many midwives took client’s religion into account, few knew much about Islamic
beliefs on prenatal screening for congenital anomalies. Midwives identified a need
for additional education. To meet the needs of the changing client population, counselors
need more knowledge of religious opinions about the termination of pregnancy and the
skills to approach religious issues with clients.